Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult penile urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulas associated with lichen sclerosis, obliterated urethra, or those occurring after previous surgery for hypospadias. Success rates in these patient populations have improved when compared to earlier techniques. It has nevertheless become clear that some patients will require more than two procedures to complete the reconstruction. However, based on recent experience there may be an opportunity to complete a higher percentage of these repairs in two operations using additional oral mucosa at the time of urethral tubularization. In addition, there are patients who will be content with their voiding pattern after the first operation and elect to forego second stage tubularization. Thorough preoperative evaluation and patient counseling are therefore critical in order to achieve successful surgical outcomes and avoid unnecessary graft harvest. In this chapter we review the surgical technique of contemporary staged urethroplasty for penile urethral stricture, and summarize previously published work.
Russell RH. The treatment of urethral stricture by excision. Br J Surg. 1914;2(7):375–83.CrossRefGoogle Scholar
Schreiter F. Mesh-graft urethroplasty: our experience with a new procedure. Eur Urol. 1984;10(5):338–44.CrossRefGoogle Scholar
Schreiter F, Noll F. Mesh graft urethroplasty using split thickness skin graft or foreskin. J Urol. 1989;142(5):1223–6.CrossRefGoogle Scholar
Spilotros M, Sihra N, Malde S, et al. Buccal mucosal graft urethroplasty in men-risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft. Transl Androl Urol. 2017;6(3):510–6.CrossRefGoogle Scholar